Healthcare Provider Details

I. General information

NPI: 1407264583
Provider Name (Legal Business Name): MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 S BLUE ISLAND AVE
CHICAGO IL
60608-3012
US

IV. Provider business mailing address

26460 NETWORK PL
CHICAGO IL
60673-3012
US

V. Phone/Fax

Practice location:
  • Phone: 773-738-3111
  • Fax: 773-738-5211
Mailing address:
  • Phone: 773-257-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEB CAPUTO
Title or Position: MANAGER
Credential:
Phone: 773-257-2905